More and more medical procedures for removing a targeted mass or specimen of tissue or an organ from the abdomen of a patient are accomplished laparoscopically to minimize scarring, infection, pain and other trauma. Typically the tissue specimen or organ is detached or freed from surrounding tissue using any conventional surgical techniques. Once that tissue specimen is free, it is ready for removal through the small incision into the abdomen (or via a suitable natural body orifice). If the targeted tissue specimen is too large to be removed as a whole unit through the incision or orifice, which quite commonly the case, the surgeon can resect it as necessary to reduce it in size or to a minimum of multiple pieces suitable for passing through the incision or orifice. Many of such procedures make use of a morcellator to reduce the size of the tissue specimen or organ.
As is known, morcellators are surgical instruments which typically take the form of a hollow cylinder that penetrates the abdominal wall and has a free distal end in the form of a high speed moving cutter or blade. Many morcellators include a central lumen or passageway through which a grasping instrument can be inserted to pull the tissue to be removed into a rotating cutter or blade to sever an extractable piece of that tissue, which is withdrawn out of the morcellator through its central passageway. While morcellators are effective for removing tissue from the body of the patient, the high-speed cutting action may free up some cells or other biological material, which can be dispersed within the peritoneal cavity. Thus, for example, if the tissue being removed is not known to be cancerous, but is in fact cancerous, there could be a release of cancer cells throughout the peritoneal cavity and from there elsewhere. Hence, it is possible for the process of morcellation to have an adverse effect on the patient.
In US2015/0320409, which is assigned to the same assignee as the subject invention, there is disclosed and claimed a system which addresses that problem by providing entrapment and collection systems and methods of entrapping and collecting biologic material produced during morcellation. Those systems include a collection bag which formed of a flexible sheet material having a hollow interior, a first mouth and a second mouth. The first mouth is openable to enable the biological structure to be disposed in the hollow interior and to enable a removal instrument, e.g., a morcellator, to be introduced therethrough to engage the biologic structure to effect a procedure on it. The second mouth enables a viewing instrument to be extended through it for visualizing the procedure and is closeable by a drawstring to entrap biologic material produced by the procedure after the removal instrument and viewing instrument have been removed, whereupon the collection bag may be withdrawn from the body of the patient.
Other systems have been disclosed in the patent literature to address the problem of containment of material produced during a morcellation procedure within the abdomen of a patent by means of a containment bag. For example, WO2015/164591 discloses a cut-resistant tissue guard removably insertable into a containment bag. The tissue specimen is isolated and contained within the containment bag and the guard is configured to protect the containment bag and surrounding tissue from incidental contact with sharp instrumentation used during morcellation and extraction of the tissue specimen. The guard is adjustable for easy insertion and removal and configured to securely anchor to the body opening. Protection-focused and containment-based systems for tissue removal are provided that enable minimally invasive procedures to be performed safely and efficiently. US2013/0184536 discloses a bag with one or more openings which is placed within a body cavity. Excised tissue is placed within the opening of a deflated bag. One or more opening in the bag are withdrawn outside the body cavity and the bag is inflated. Instruments, including laparoscopic visualization are placed within the inflated bag that remains within the body cavity. The tissue retained within the body cavity is morcellated/crushed/reduced and removed. The bag is deflated and removed with the residual tissue/blood/fluids inside. The tissue to be removed is retained in the bag which prevents potentially harmful material such as cancerous cells from being released in the body cavity.
The patent literature also includes various other relatively small, rolled-up or folded bags or pouches that are deployed and opened in the abdominal cavity where tissue is placed in them and then they are closed for retraction. See, for example, U.S. Pat. Nos. 8,652,147, 8,486,087, 8,409,112, 7,650,887, 6,409,733, 5,647,372, 2009/0043315, 2009/0192510 and 2008/0221588.
In our co-pending U.S. patent application Ser. No. 14/986,890, filed on Jan. 4, 2016, entitled Systems For Removing A Tissue Specimen Or Organ Through A Small Incision Or Natural Opening In A Patient, which is assigned to the same assignee as the subject invention, and whose entire disclosure is incorporated by reference herein, there is disclosed and claimed a system and method for effecting the removal of a tissue specimen or organ through a small incision in the body of a patient making use of a collection bag and associated cutter components. That system is simple in construction and easy to use, which eliminates the need for power morcellators while minimizing the chances of dispersion of unwanted portions of the tissue specimen or organ, cells or other biological material into the peritoneum or other internal portion of the body in which the tissue specimen or organ is located. In particular, the system of that published application includes a device for cutting the tissue specimen or organ. The device comprises a passer and a wire. The passer comprises a long flexible member having a distal end and a proximal end. The passer has an opening located adjacent the distal end and extending backward toward the proximal end. The wire serves as the cutter for the system and has a distal end and a proximal end. The distal end of the wire is connected to the passer adjacent the proximal end of the passer. The distal end of the passer is configured to be introduced through the mouth portion of the bag or pouch to pass between the interior surface of the bag or pouch and the tissue specimen or organ in a path around the tissue specimen or organ and back out through the mouth portion of the bag or pouch to carry the wire around the tissue specimen or organ through that path so that the distal end of the wire is located outside the body of the patient and a proximal portion of the wire is also located outside the body of the patient. The distal end portion of the wire and the proximal portion of the wire are configured to be pulled so that the wire cuts though the tissue specimen or organ within the bag or pouch to form plural pieces. The plural pieces of the tissue specimen or organ can then be removed through the mouth portion of the bag or pouch while the bag or pouch is within the body of the patient.
While the device of our aforementioned published patent application is suitable for its intended purposes, it nevertheless leaves something to be desired from the standpoint of ease of use of the cutter. Thus, a need exists for a system and methods of use which overcome the drawbacks of the prior art. The subject invention addresses that need.